Quality Improvement Project

Ventilator Associated Pneumonia

(VAP)

Courtney Whyte
Addelyn Villalobos
Sydney Wren
Anna Lusnia
Landon Howard
The Problem

Ventilator Associated Pneumonia (VAP)1

● Most common infection in Intensive Care Units (ICU)

● Increased rate of mortality and morbidity
● Large hospital costs
● Practice compliance
The Plan: Goals & Objectives

Goal:
Reduce the number of patients acquiring VAP

Objectives:

● Identify problematic areas in current practice

● Educate all health care team members
● Implement new protocol for VAP prevention
Do: Involve The Entire
Interprofessional Team

● Physicians
● Nurses
● Respiratory Therapists
● Physical Therapists
● Patient Care Technicians
● Pharmacists
● Facility Management Representatives
● Risk Management
Do: Evaluate Current Practice2

Nursing Interventions
● Regular oral care
● Subglottic suctioning
● Position and mobility maintenance
Physician Practice
● Minimize ventilation whenever possible
Management Practice
● Ensure adequate staffing
Study: Analysis of Data3

Regular Oral Care

● Prevents colonization in the upper airway

● Reduces risk of VAP 67- 72%

Subglottic Suctioning

● Removes pooling secretions above ETT cuff

● Increases time to first VAP by 2.6 days
Study: Analysis of Data3

Position and Mobility Maintenance

● Elevate head of bed to reduce aspiration

● Shown to lower the chance of VAP by 26%

Minimize Ventilation

● Non-invasive positive pressure ventilation

● Shown to lower risk of VAP
Study: Contributing Factors4

● Resources and supplies

● Compliance
● Education
● Collaboration
● Systematic Intervention
● Widespread implementation
Act: VAP Bundle5

● Minimize sedation
● Assess readiness to extubate daily
● Maintain and improve physical conditioning
● Regular oral care
● Subglottic suctioning
● Elevate head of bed
● Minimize ventilation
Act: VAP Reduction

Since initiation of the VAP bundle:6

VAP rates dropped from 10.2 cases/1000 ventilator days to

3.4 cases/1000 ventilator days and it saved facilities an
estimated $10.8 million
Act: Ensuring New Practices

Establishing committees dedicated to VAP prevention

● Committees comprised of healthcare members in each unit

Quarterly audits

● Inspection of appropriate usage of VAP prevention bundles

● Data used for further improvement

Real-time computerized dashboard7

● Initiates instant correction of noncompliant parameters

References
1. Abd-Elmonsef, M. M., Elsharawy, D., & Abd-Elsalam, A. S. (2017). Mechanical ventilator as a major cause of
infection and drug resistance in intensive care unit. Environmental Science and Pollution Research,25(31),
30787-30792. doi:10.1007/s11356-017-8613-5
2. American Nurses Association. (2017). 5 nursing strategies to prevent ventilator-associated pneumonia. Vol
12(6). Retrieved from https://www.americannursetoday.com/5-nursing-strategies-prevent-ventilator -associated-
pneumonia/
3. Keyt, H., Faverio, P., & Restrepo, M. I. (2014). Prevention of ventilator-associated pneumonia in the intensive
care unit: a review of the clinically relevant recent advancements. The Indian Journal of Medical Research,
139(6), 814-21.
4. Rodrigues, Ana Natesia, Fragoso, Luciana Vládia e Cavalhedo, Beserra, Francisca de Melo, & Ramos, Islane
Costa. (2016). Determining impacts and factors in ventilator-associated pneumonia bundle. Revista Brasileira de
Enfermagem, 69(6), 1108-1114. https://dx.doi.org/10.1590/0034-7167-2016-0253
5. Klompas, M., Branson, R., Eichenwald, E.C., Greene, L.R., Howell, M.D., Lee, G., Magill, S.S., Maragakis, L.L.,
Priebe, G.P., Speck, K., Yokoe, D.S., & Berenholtz, S.M. (2014). Strategies to prevent ventilator-associated
pneumonia in acute care hospitals: 2014 update. Infection Control and Hospital Epidemiology, 35(8), 915-936
6. Bird, D., Zambuto, A., O’Donnell, C., Silva, J., Korn, C., Burke, R., Burke, P., & Argarwal, S. (2010). Adherence
to ventilator-associated pneumonia bundle and incidence of ventilator-associated pneumonia in the surgical
intensive care unit. Arch Surg, 145(5):465–470. doi:10.1001/archsurg.2010.69
7. Talbot, T., Carr, D., Lee Parmley, C., Martin, B., Gray, B., Ambrose, A., & Starmer, J. (2015). Sustained Reduction of
Ventilator-Associated Pneumonia Rates Using Real-Time Course Correction With a Ventilator Bundle
Compliance Dashboard. Infection Control & Hospital Epidemiology, 36(11), 1261-1267. doi:10.1017/ice.2015.180